Background: Colorectal cancer is a significant health concern. Immunotherapy has become a promising approach in colorectal cancer, offering a wider array of therapeutic strategies. This study aims to summarize the current evidence regarding the use of checkpoint inhibitors in metastatic colorectal cancer. Methods: A systematic review of relevant clinical trials and randomized controlled trials (RCTs) assessing checkpoint inhibitors, published between January 2019 and January 2025, was conducted on Medline, Web of Science, and Cochrane. Progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) were the primary outcomes. Studies focusing on other types of immunotherapy, non-clinical trials, pre-clinical trials, and study protocols were excluded. Results: 48 studies were included. Checkpoint inhibitors demonstrated significant efficacy in microsatellite instability (MSI) metastatic colorectal cancer (mCRC). In microsatellite stability (MSS) mCRC, immunotherapy was less effective, and combination strategies with chemotherapy or targeted therapies yielded mixed results. Grade ≥ 3 treatment-related adverse events (TRAEs) were common in combination regimens. Conclusion: Immunotherapy has revolutionized MSI mCRC treatment while treating MSS CRC with these molecules remains unconvincing. Combination strategies and novel agents may offer potential but require further research to prove efficacy.
背景：结直肠癌是一个重要的健康问题。免疫疗法已成为结直肠癌治疗中一种前景广阔的方法，提供了更广泛的治疗策略。本研究旨在总结目前关于检查点抑制剂在转移性结直肠癌中应用的证据。方法：在Medline、Web of Science和Cochrane数据库中对2019年1月至2025年1月期间发表的评估检查点抑制剂的相关临床试验和随机对照试验进行了系统综述。主要结局指标包括无进展生存期、总生存期和客观缓解率。研究排除了关注其他类型免疫疗法、非临床试验、临床前试验和研究方案的文章。结果：共纳入48项研究。检查点抑制剂在微卫星不稳定性转移性结直肠癌中显示出显著疗效。在微卫星稳定性转移性结直肠癌中，免疫疗法效果较差，与化疗或靶向治疗的联合策略效果不一。联合治疗方案中≥3级治疗相关不良事件较为常见。结论：免疫疗法已彻底改变了微卫星不稳定性转移性结直肠癌的治疗，但使用这些药物治疗微卫星稳定性结直肠癌的效果仍不明确。联合治疗策略和新药可能具有潜力，但需要进一步研究以证明其疗效。
Immune Checkpoint Inhibitors for Metastatic Colorectal Cancer: A Systematic Review
肿瘤(癌症)患者之家